UNIVERSITY STUDENT HEALTH SERVICES • Fact Sheet OSTEOPOROSIS WHAT IS IT?
Osteoporosis is a disease that causes a significant loss in bone mass. This means that the inside of bones becomes weak and porous, making them more likely to break. Even minor trauma can cause a fracture. Fractures can result in loss of function, pain, and deformity, as well as life-threatening conditions, such as pneumonia and blood clots. Hip fractures in older adults can cause permanent disability and even death. Bone mass is normally maintained by the balanced activity of 2 types of cells: osteoclasts, which break down old bone, and osteoblasts, which build new bone. 85-90% of adult bone mass is acquired by the late teens. After bone mass peaks around age 35, all adults start to lose bone mass because more bone is destroyed than replaced. Women are at higher risk for osteoporosis because they have a lower peak bone mass than men. In addition, once a woman reaches menopause and estrogen levels fall, the rate of bone loss increases even further. This is because estrogen is needed to promote bone growth. Women can lose up to 20% of their bone mass in the first 5-7 years after menopause. WHO GETS IT? In the United States, approximately 10 million people have osteoporosis. Another 34 million have low bone mass, which puts them at risk for developing osteoporosis. 80% of adults with osteoporosis are women. While osteoporosis is most commonly found in post-menopausal women, it can affect young women with eating disorders and women who menstruate infrequently. Risk factors for osteoporosis Certain genetic and environmental factors are clearly associated with the development of osteoporosis. They include the following: Caucasian or Asian race
Lack of regular weight-bearing exercise
Surgery removing the ovaries before menopause
Infrequent or absent menstrual periods before menopause Long-term use of oral steroids and some Low testosterone levels (in men)
WHAT ARE THE SYMPTOMS? Osteoporosis does not cause any symptoms until a fracture develops from weakened bones. In the United States, 1 in 2 women and 1 in 4 men over the age of 50 will have an osteoporosis-related fracture. Fractures most commonly occur in the hip, wrist, or spine. Other signs of osteoporosis include a hunched back or persistent back pain due to fractured vertebrae in the spine. HOW IS IT DIAGNOSED? Unfortunately, by the time osteoporosis causes symptoms, a significant amount of bone loss has already occurred. Regular x- rays do not reveal changes in bones until 20-50% of bone mass has been lost. Therefore, it is important for women at risk of osteoporosis to consider getting screened with a bone density test before symptoms develop. Bone density is measured using the dual energy x-ray absorptiometry (DEXA) scan. This test measures bone density in the wrist, hip, and lower spine. If bone mass is low but not severe enough to be osteoporosis, it is called osteopenia. Screening with a DEXA scan is usually reserved for women over the age of 65 or post-menopausal women under 65 with additional risk factors. WHAT CAN BE DONE TO PREVENT IT? Building strong bones in childhood and adolescence can prevent osteoporosis later in life. The following suggestions will help you improve peak bone mass, as well as decrease bone loss as you age. Engage in regular weight-bearing exercises. This means exercises that involve gravity and muscle tension on the
bone. Most activities are weight-bearing, except for swimming. Try to exercise for at least 30 minutes most days of the week.
Avoid smoking. Recent studies have shown a direct relationship between smoking and decreased bone density.
Smoking may increase the risk of fractures, as well as decrease estrogen levels.
Limit alcohol consumption to 1 drink per day. One drink is equivalent to 12 oz of beer, 5 oz of wine, or 1.5 oz of
liquor. Excess alcohol use can interfere with the absorption of nutrients needed by bones.
Avoid consuming large amounts of sodium, caffeine, and protein. Higher levels of these substances can lead to
greater loss of calcium through the urine.
See your health care provider if you are premenopausal and having infrequent menstrual periods. Your estrogen
Get enough calcium and vitamin D. Calcium is needed for bone growth, and your body cannot absorb calcium without
sufficient vitamin D. It is best to consume these nutrients from food, but supplements are available if needed.
Consider medication. If a DEXA scan reveals osteopenia (low bone mass not severe enough to be classified as
osteoporosis), your health care provider may recommend starting medication to prevent further bone loss.
CALCIUM The average American consumes only 500 mg of calcium in their diet. This is less than the daily calcium requirements listed below. Please refer to the table below for a list of the calcium content of common foods. RECOMMENDED DAILY CALCIUM INTAKE (SOURCE: NIH OFFICE OF DIETARY SUPPLEMENTS) Young Adults
Which calcium supplements are preferred? Calcium carbonate (Tums, Caltrate, Os-Cal) contains the most elemental calcium per tablet and is the least expensive.
Elemental calcium is the actual amount of calcium in each supplement. Because calcium carbonate requires stomach acid for absorption, it is best to take this form of calcium with food.
Calcium citrate (Citracal) and calcium gluconate are more easily absorbed and can be taken on an empty stomach. They
are also preferable if you are taking an acid-blocking medication (such as Zantac, Prilosec, Nexium, etc). However, they contain less elemental calcium than calcium carbonate.
Tips on taking calcium Calcium is best absorbed when no more than 600 mg is taken at one time. Taking calcium supplements with meals,
lactose (ie. a sip of milk), or vitamin D (also in fortified milk) enhances their absorption.
Consult your health care provider prior to increasing your calcium intake if your family has a history of calcium-containing
Do not exceed 2000 mg/day of calcium as high doses may damage the kidneys. VITAMIN D The daily requirement for vitamin D is 400-600 IU for most people and 800 IU for postmenopausal women. Vitamin D is made naturally by the skin after exposure to sunlight. Being in the sun for 15 minutes a day is usually
enough to produce all the vitamin D needed by the body.
Vitamin D is also found in egg yolks, saltwater fish, and fortified cereals and dairy products. Supplements are available if needed, and most multivitamins contain 400 IU per dose. Do not consume more than the dose recommended by your health care provider, as high doses of vitamin D can be
WHAT ARE THE TREATMENTS? Although there is no cure, several medications are available for the treatment and prevention of osteoporosis. Most medications work by decreasing bone loss. Only one medication, teriparatide (Forteo), helps to increase bone growth. Research is ongoing in this area. Even if you are on medication, it is important to continue adequate calcium and vitamin D intake, as well as the other lifestyle changes reviewed above. Consult your health care provider for further information regarding treatment. CALCIUM CONTENT OF FOODS
_________________________________________________________________________________________________________________ Published by:
Wellness Resource Center (828-WELL) & University Student Health Services Virginia Commonwealth University/Division of Student Affairs and Enrollment Services
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